Time from breast cancer diagnosis to therapeutic surgery and breast cancer prognosis : a population-based cohort study

Theoretically, time from breast cancer diagnosis to therapeutic surgery should affect survival. However, it is unclear whether this holds true in a modern healthcare setting in which breast cancer surgery is carried out within weeks to months of diagnosis. This is a population- and register-based study of all women diagnosed with invasive breast cancer in the Stockholm-Gotland healthcare region in Sweden, 2001 - 2008, and who were initially operated. Follow-up of vital status ended 2014. 7017 women were included in analysis. Our main outcome was overall survival. Main analyses were carried out using Cox proportional hazards models. We adjusted for likely confounders and stratified on mode of detection, tumor size and lymph node metastasis. We found that a longer interval between date of morphological diagnosis and therapeutic surgery was associated with a poorer prognosis. Assuming a linear association, the hazard rate of death from all causes increased by 1.011 (95% CI 1.006 to 1.017) per day. Comparing, e.g., surgery 6 weeks after diagnosis to surgery 3 weeks after diagnosis, thereby confers a 1.26-fold increased hazard rate. The increase in hazard rate associated with surgical delay was strongest in women with largest tumors. Whilst there was a clear association between delays and survival in women without lymph node metastasis, the association may be attenuated in subgroups with increasing number of lymph node metastases. We found no evidence of an interaction between time to surgery and mode of detection. In conclusion, unwarranted delays to primary treatment of breast cancer should be avoided.Swedish Research CouncilSwedish Cancer SocietyStockholm County CouncilFORTEAccepte

Genotyping of human papillomavirus in triaging of low-grade cervical cytology.

OBJECTIVE: The objective of the study was to evaluate whether typing of human papillomavirus (HPV) among women with low-grade cervical cytology can improve the ability to identify women with cervical cancer or cervical intraepithelial neoplasia grade III (CIN III or worse). STUDY DESIGN: A total of 1595 women with low-grade cervical cytology participating in a randomized implementation trial of HPV triaging using Hybrid Capture II were also HPV genotyped and CIN III or worse predictive values evaluated. RESULTS: HPV 16 was detected in 57% of cases with CIN III or worse but only among 24% of all tested women. Testing for the 3 HPV types with highest risk (HPV16/31/33) detected 77% of CIN III or worse, with 36% of women testing positive. Positivity for the other high-risk HPV types had a decreased risk for CIN III or worse. CONCLUSION: Different high-risk HPV types confer different risks for the presence of CIN III or worse, implying that HPV genotyping could be useful for the optimization of triaging strategies

Risk factors and tumor characteristics of interval cancers by mammographic density

Purpose: To compare tumor characteristics and risk factors of interval breast cancers and screen-detected breast cancers, taking mammographic density into account. Patients and Methods: Women diagnosed with invasive breast cancer from 2001 to 2008 in Stockholm, Sweden, with data on tumor characteristics (n 4,091), risk factors, and mammographic density (n 1,957) were included. Logistic regression was used to compare interval breast cancers with screen- detected breast cancers, overall and by highest and lowest quartiles of percent mammo- graphic density. Results: Compared with screen-detected breast cancers, interval breast cancers in nondense breasts ( 20% mammographic density) were significantly more likely to exhibit lymph node involvement (odds ratio [OR], 3.55; 95% CI, 1.74 to 7.13) and to be estrogen receptor negative (OR, 4.05; 95% CI, 2.24 to 7.25), human epidermal growth factor receptor 2 positive (OR, 5.17; 95% CI, 1.64 to 17.01), progesterone receptor negative (OR, 2.63; 95% CI, 1.58 to 4.38), and triple negative (OR, 5.33; 95% CI, 1.21 to 22.46). In contrast, interval breast cancers in dense breasts ( 40.9% mammographic density) were less aggressive than interval breast cancers in nondense breasts (overall difference, P .008) and were phenotypically more similar to screen-detected breast cancers. Risk factors differentially associated with interval breast cancer relative to screen- detected breast cancer after adjusting for age and mammographic density were family history of breast cancer (OR, 1.32; 95% CI, 1.02 to 1.70), current use of hormone replacement therapy (HRT; OR, 1.84; 95% CI, 1.38 to 2.44), and body mass index more than 25 kg/m2 (OR, 0.49; 95% CI, 0.29 to 0.82). Conclusion: Interval breast cancers in women with low mammographic density have the most aggressive phenotype. The effect of HRT on interval breast cancer risk is not fully explained by mammographic density. Family history is associated with interval breast cancers, possibly indicating disparate genetic background of screen-detected breast cancers and interval breast cancers.Swedish Research CouncilSwedish Cancer SocietyStockholm County CouncilLinneus Centre - Swedish Research CouncilSwedish E-science Research CouncilCancer Risk Prediction CenterPublishe

European guidelines for quality assurance in breast cancer screening and diagnosis. Fourth edition - summary document

Rak piersi jest najczęstszą przyczyna zgonu wśród kobiet i stanowi istotny problem kliniczny. Wczesne wykrycie raka piersi dzięki regularnie prowadzonym badaniom przesiewowym za pomocą mammografii umożliwia rozpoznanie choroby w stadium, w którym leczenie jest skuteczniejsze i zazwyczaj wiąże się z lepszą jakością życia. Jednakże mammografia może być przyczyną niepotrzebnego stresu, dolegliwości, kosztów finansowych oraz narażenia na promieniowanie jonizujące. Z tego powodu należy położyć możliwie największy nacisk na kontrolę jakości. Opracowanie Europejskich zaleceń dotyczących kontroli jakości badań przesiewowych i rozpoznawania raka piersi było inicjatywą programu Europa przeciwko rakowi. Czwartą edycję interdyscyplinarnych zaleceń opublikowano w 2006 roku. Składa się z około 400 stron podzielonych na 12 rozdziałów przygotowanych przez ponad 200 autorów i współautorów. Interdyscyplinarna rada wydawnicza przygotowała streszczenie dokumentu w celu przedstawienia podstawowych zasad i założeń, na których powinny opierać się badania przesiewowe oraz diagnostyka raka piersi. Opracowanie zawiera także tabelę podsumowującą wskaźniki wydajności, aby szersze grono naukowców mogło się z nią zapoznać.Breast cancer is a major cause of suffering and death and is of significant concern to many women. Early detection of breast cancer by systematic mammography screening can find lesions for which treatment is more effective and generally more favourable for quality of life. The potential harm caused by mammography includes the creation of unnecessary anxiety and morbidity, inappropriate economic cost and the use of ionising radiation. It is for this reason that the strongest possible emphasis on quality control and zmniejquality assurance is required. Development of the European Guidelines for Quality Assurance in Breast Cancer Screening and Diagnosis has been an initiative within the Europe Against Cancer Programme. The fourth edition of the multidisciplinary guidelines was published in 2006 and comprises 400 pages divided into 12 chapters prepared by >200 authors and contributors. The multidisciplinary editorial board has prepared a summary document to provide an overview of the fundamental points and principles that should support any quality screening or diagnostic service. This document includes a summary table of key performance indicators and is presented here in order to make these principles and standards known to a wider scientific communit

Determinants of successful implementation of population-based cancer screening programmes

Prezentujemy Państwu tłumaczenie artykułu poświęconego organizacji skriningów populacyjnych. Grupa ekspertów uznanych w dziedzinie badań skriningowych zebrała i w syntetycznej formie przedstawiła najważniejsze warunki, których spełnienie jest konieczne, aby można było mówić o dobrze funkcjonującym skriningu. Artykuł wydaje nam się na tyle cenny, że postanowiłyśmy przybliżyć go osobom, które są lub będą włączone w organizację i realizację skriningu w Polsce. Stanowi on rozwinięcie artykułu zatytułowanego Zalecenia komitetu ekspertów działającego w ramach projektu EuSANH dla Ministra Zdrowia w sprawie organizacji skriningów populacyjnych, opublikowanego w „Nowotwory Journal of Oncology” 2014, 64, 5. W celu ułatwienia realizacji populacyjnych programów badań przesiewowych w kierunku nowotworów podsumowano dotychczas zdobyte w Europie doświadczenia w tym zakresie. Wymieniono w punktach najważniejsze kwestie, które obywatele, grupy rzeczników, politycy, osoby organizujące opiekę zdrowotną oraz pracownicy służby zdrowia powinni rozważyć podczas planowania, realizacji i prowadzenia badań przesiewowych w kierunku raka. Lista jest na tyle ogólna, że ma zastosowanie zarówno do skriningu raka piersi, jak i szyjki macicy oraz jelita grubego. Lista powstała na podstawie dowodów przedstawionych w trzech publikacjach Unii Europejskiej, zawierających wytyczne w sprawie kontroli jakości badań przesiewowych i diagnostyki raka. Dodatkowo została wzbogacona piś miennictwem oraz doświadczeniami ekspertów prezentowanymi w czasie warsztatu w ramach European Science Advisory Network. Realizacja programu badań przesiewowych w kierunku raka powinna być podzielona na siedem etapów: 1) przygotowanie do planowania, 2) kompleksowe planowanie, 3) badanie wykonalności, 4) pilotaż i wdrożenie procesu, 5) rozwój serwisu usług skriningowych, 6) uruchomienie programu badań przesiewowych na dużą skalę oraz 7) zapewnienie trwałości. O realizacji każdego etapu można mówić jedynie wtedy, gdy zostanie spełniona określona liczba warunków. Pomyślna realizacja programu badań przesiewowych wymaga akceptacji społecznej oraz użycia najlepszych praktyk opartych na dowodach i weryfi kacji adekwatności wykonania na każdym etapie realizacji

Breast cancer genetic risk profile is differentially associated with interval and screen-detected breast cancers

Background: Polygenic risk profiles computed from multiple common susceptibility alleles for breast cancer have been shown to identify women at different levels of breast cancer risk. We evaluated whether this genetic risk stratification can also be applied to discriminate between screen-detected and interval cancers, which are usually associated with clinicopathological and survival differences. Patients and methods: A 77-SNP polygenic risk score (PRS) was constructed for breast cancer overall and by estrogen-receptor (ER) status. PRS was inspected as a continuous (per standard deviation increment) variable in a case-only design. Modification of the PRS by mammographic density was evaluated by fitting an additional interaction term. Results: PRS weighted by breast cancer overall estimates was found to be differentially associated with 1,865 screen-detected and 782 interval cancers in the LIBRO-1 study (age-adjusted ORperSD [95% confidence interval]=0.91 [0.83-0.99], p=0.023). The association was found to be more significant for PRS weighted by ER-positive breast cancer estimates (ORperSD=0.90 [0.82-0.98], p=0.011). This result was corroborated by two independent studies (combined ORperSD=0.87 [0.76-1.00], p=0.058) with no evidence of heterogeneity. When enriched for “true” interval cancers among nondense breasts, the difference in the association with PRS in screen-detected and interval cancers became more pronounced (ORperSD=0.74 [0.62-0.89], p=0.001), with a significant interaction effect between PRS and mammographic density (pinteraction=0.017). Conclusion: To our knowledge, this is the first report looking into the genetic differences between screendetected and interval cancers. It is an affirmation that the two types of breast cancer may have unique underlying biology.Swedish Research CouncilSwedish Cancer SocietyStockholm County CouncilBreast Cancer Theme Centre Consortium (BRECT)Accepte

Screening and cervical cancer cure: population based cohort study

Objective To determine whether detection of invasive cervical cancer by screening results in better prognosis or merely increases the lead time until death

Beneficial Effect of Consecutive Screening Mammography Examinations on Mortality from Breast Cancer: A Prospective Study

BackgroundPreviously, the risk of death from breast cancer was analyzed for women participating versus those not participating in the last screening examination before breast cancer diagnosis. Consecutive attendance patterns may further refine estimates.PurposeTo estimate the effect of participation in successive mammographic screening examinations on breast cancer mortality.Materials and MethodsParticipation data for Swedish women eligible for screening mammography in nine counties from 1992 to 2016 were linked with data from registries and regional cancer centers for breast cancer diagnosis, cause, and date of death (Uppsala University ethics committee registration number: 2017/147). Incidence-based breast cancer mortality was calculated by whether the women had participated in the most recent screening examination prior to diagnosis only (intermittent participants), the penultimate screening examination only (lapsed participants), both examinations (serial participants), or neither examination (serial nonparticipants). Rates were analyzed with Poisson regression. We also analyzed incidence of breast cancers proving fatal within 10 years.ResultsData were available for a total average population of 549 091 women (average age, 58.9 years ± 6.7 [standard deviation]). The numbers of participants in the four groups were as follows: serial participants, 392 135; intermittent participants, 41 746; lapsed participants, 30 945; and serial nonparticipants, 84 265. Serial participants had a 49% lower risk of breast cancer mortality (relative risk [RR], 0.51; 95% CI: 0.48, 0.55; P P ConclusionWomen participating in the last two breast cancer screening examinations prior to breast cancer diagnosis had the largest reduction in breast cancer death. Missing either one of the last two examinations conferred a significantly higher risk.Published under a CC BY 4.0 license.</p

European code against cancer 4th edition: 12 ways to reduce your cancer risk

This overview describes the principles of the 4th edition of the European Code against Cancer and provides an introduction to the 12 recommendations to reduce cancer risk. Among the 504.6 million inhabitants of the member states of the European Union (EU28), there are annually 2.64 million new cancer cases and 1.28 million deaths from cancer. It is estimated that this cancer burden could be reduced by up to one half if scientific knowledge on causes of cancer could be translated into successful prevention. The Code is a preventive tool aimed to reduce the cancer burden by informing people how to avoid or reduce carcinogenic exposures, adopt behaviours to reduce the cancer risk, or to participate in organised intervention programmes. The Code should also form a base to guide national health policies in cancer prevention. The 12 recommendations are: not smoking or using other tobacco products; avoiding second-hand smoke; being a healthy body weight; encouraging physical activity; having a healthy diet; limiting alcohol consumption, with not drinking alcohol being better for cancer prevention; avoiding too much exposure to ultraviolet radiation; avoiding cancer-causing agents at the workplace; reducing exposure to high levels of radon; encouraging breastfeeding; limiting the use of hormone replacement therapy; participating in organised vaccination programmes against hepatitis B for newborns and human papillomavirus for girls; and participating in organised screening programmes for bowel cancer, breast cancer, and cervical cancer